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Post-thyroidectomy voice and swallowing therapy

Updated: Jul 5, 2022


What is Thyroidectomy?


Thyroidectomy is a surgical procedure in which either complete or partial removal of the thyroid gland is performed by a surgeon under general anesthesia.

The thyroid is a gland situated in the neck which controls all the activities of a human body from the rate of heartbeat to metabolism.


Why is Thyroidectomy done?


This is performed if there's a cancerous lesion of the thyroid or non-cancerous lesion (Goiter- enlargement of thyroid gland), thyroid nodules, enlargement of nodes in the neck region which causes difficulty breathing and swallowing, etc.

Based on the depth of lesion and site of lesion either partial thyroidectomy or total thyroidectomy is performed.



Common problems seen post thyroidectomies are

  • Dysphonia (trouble voicing). Patients usually exhibit hoarseness of voice, breathiness, and increased vocal effort. Recurrent laryngeal nerve damage, results in temporary or permanent hoarseness.

  • Dysphagia (trouble swallowing) can be caused by Intubation and Recurrent laryngeal nerve palsy (RLN).

It is advised to do a pre-operative assessment of voice and swallowing when thyroidectomy is planned just before the surgery.


Speech-Language pathologist plays a major role in treating Dysphonia and Dysphagia.


 


How can a speech-language pathologist help during the pre-operative period?


During the pre-operative period, one should be explained about complications post-surgery. Though there are several surgical options available to treat vocal fold paralysis, speech pathologists have experience in providing voice therapy and swallowing therapy which in turn can improve voice as well as swallowing abilities.


If treatment for dysphagia and dysphonia (hoarseness of voice) isn't started as early as possible, this could lead to malnutrition, and aspiration pneumonia, and also leads to the inability to communicate respectively. However, appropriate treatment by the speech-language pathologist post thyroidectomy at the correct time would benefit the individual from many such problems.


Pre-operative voice assessment works as a baseline assessment for an individual which can also be taken up as that particular individual's normative that needs to be achieved post-surgery.


Pre-therapy assessment is essential for establishing the treatment goals and appropriate procedures for each patient as patients who have the same diagnosis may have different symptoms and different responses to therapy. Acoustic analysis of voice and water swallow tests are the basic tests performed in the pre-operative assessment of voice and swallow respectively.



 

What leads to hoarseness of voice post-thyroidectomy?


About 10% of patients experience voice disturbance directly due to (usually) temporary and (rarely) permanent laryngeal nerve injuries after surgery.

Voice problems post-thyroidectomy include breathiness with loss of air during vocalization, change in pitch, inability to project the voice, and early vocal fatigue, any and all of which can impair communication.


Vocal fold paralysis post thyroidectomy often causes insufficient glottic closure which can then cause

  1. Dysphonic symptoms such as weakness, breathiness, reduced voice range, and loudness.

  2. Vocal fold paralysis can also cause dysphagic symptoms such as coughing, choking, and aspiration pneumonia.

  3. Because patients who have received thyroidectomy often have difficulty swallowing, another possible outcome is malnutrition.

The main goal of voice therapy is to restore voice using voice therapy techniques. Vocal hygiene and counseling play a major role in voice therapy. Usually, voice therapy is required for multiple sessions and must be performed by a speech-language pathologist with expertise in Voice disorders.


Voice therapy after thyroid surgery (thyroidectomy)


Few voice therapy techniques used for vocal fold paralysis are chant talk, ear training, head positioning and push and pull approach, etc. Vocal Function exercises show good improvement in thyroidectomy patients in regaining voice. Regular checkups and evaluations of voices provide the parameters which need to be concentrated on for further treatment.


Swallowing therapy after thyroid surgery (thyroidectomy)


Most often patients with thyroidectomy complain of the pharyngeal phase of Dysphagia. Swallowing therapy requires postural adjustment, bolus modification, and practice of appropriate swallowing maneuvers to play a major role. The main aim of swallowing therapy is to protect the individual from aspiration pneumonia and malnutrition. Techniques for improving pharyngeal swallow include, “chin tuck”, “head rotation”, “head tilt”, “effortful swallow”, “supraglottic swallow”, “oral hold” and “diet modifications”. Head and neck strengthening and relaxing exercises help for improving both swallowing and voice functions.


 

Special Considerations:


  • Wait for wound healing.

  • Do proper evaluation for swallowing and voice.

  • Confirm physician order for therapy If required.

  • Avoid heavy lifting for the first two weeks after surgery.

  • Perform gentle neck stretching exercises to reduce neck stiffness.

  • Avoid swimming or taking baths for at least a week after surgery.

  • Avoid driving for two weeks (or longer if you continue to have neck stiffness and/or you are still on pain medication).

If you or a loved one is planning a thyroidectomy surgery or is experiencing difficulties with swallowing and voice post thyroidectomy, feel free to reach out to our experienced speech-language pathologists for a consultation and steps ahead.


 

About the expert:


Ms. Alapati. Keerthi Prasanna.

Speech-language pathologist

Fellowship in Onco-deglutology from HCG hospitals Bangalore

Expert in Swallowing, Neurological, and Voice disorders

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